Uncovered

Mission ruins, San Antonio

“Mommy!” my daughter gasped urgently. “Look, she’s a mermaid…” There was reverence and surprise in her voice. 

Imagine meeting a mermaid here!

“Yes, she is…. now, shhhhhh,” I responded.

I held my breath waiting for my little girl with no filter to say something about the woman’s size. She was probably close to 400 pounds and she was wearing a two piece bright purple and turquoise mermaid swim suit like it was the most natural thing in the world.

Mercifully my daughter said nothing more. Instead she snuggled up against me wrapped in her towels and fell asleep, smiling. I am grateful that she and the towels completely cover up my thighs.

I found myself very jealous of that woman. If I could have even half of that confidence, I could… 

But then, I remembered, what I saw was probably only just the tip of the iceberg so to speak. What kind of ugly things had been uttered by people under their breath as she walked by? Was she really, truly confident or was her swim suit an act of defiance, a f**k you to the world wrapped up in flashy purple and turquoise lame fabric? I would never know the reality of what lies beneath.

In contrast to the mermaid, there was a woman who must have been a size 4 standing in the wave pool with a voluminous hot pink coverup who looked so incredibly self conscious and miserable. I felt and understood her pain. She hid her body but did not succeed in hiding her discomfort. 

“Nothing makes a woman more beautiful than the belief she is beautiful.” —Sophia Loren

I looked around me at the hundreds of other men and women, bodies of all shapes and sizes and the swimsuits of all sorts, each one an act of courage. Bacne, surgical scars, stretch marks, cellulite, fat rolls, belly bulges, love handles, etc. all exposed. 

My body is a blessing.

“You are the best looking woman out here,” he whispers in my ear as I take off my cover up. I’m not. The mermaid is, but I love that he can make me feel like he believes it is the truth. 

So I decide to walk around like I am, like I really do believe I am beautiful in my deep cobalt blue velvet one piece swimsuit. I don’t like my body but that is OK. I am not this body. I am not this swimsuit. 

I am beautiful.

Doctor’s Day

Cute butterfly on a blossom

Doctor’s Day was yesterday. Did you know that?

Caught me completely by surprise.

It used to be a big thing ten years ago. The hospital hung banners up and handed out logo emblazoned umbrellas, bags, pens, and whatnot. My staff signed a big card the office manager picked up and a new potted plant would now sit on my desk. Drug reps dropped off cards and swag. There would be emails celebrating doctors sent from the suits. Well not really from the suits. From their secretaries. The point was, though, you just could not escape what day it was. 

To be honest, all of the hoopla back then made me feel very uncomfortable. 

This is not why I am doing this. I am not here for the accolades or the potted plants and I resent the insinuation that these things matter to me. Please leave me alone.

Each year it is less and less of a big deal. This year? Silence. Not a single frickin word from anyone. In fact, my only clue was a post from someone else on WordPress. 

Yesterday I told a woman she has metastatic ovarian cancer. I told a man that he now has diabetes and we developed a treatment plan together. I did a newborn visit on a precious two week old baby. I cried with a woman over her divorce and saw a man whose mother just died from the same disease he now has. Then I watched the last few minutes of my son’s karate class and picked up cupcakes for my daughter’s class party. 

This is life. My life. Every day. 

And you know what? Despite any bitching and complaining that I do here, I really, really love my job. It is such an honor and a privilege to care for people, to be there when they need help. THAT is what keeps us going… keeps me going.

In truth, I’d do this job for free. Just don’t tell the suits that I said that. 😉

A touch of tenderness

This is a wonderful post about the importance of touch in life and death. Please pop over and read it if you have not done so already.

Sue Vincent's Daily Echo

The Cathedral by Rodin.

My son gleefully squeezed harder at the knotted muscle in my shoulder, with a ‘Now I’ve got you’ as I groaned in agony. We have established and agreed that he has a slightly sadistic tendency where I am concerned. It may have something to do with my knack of getting just the right spot on the painful muscles as we got his body working again. Day after painful day, for months on end. So now it is payback… and he appears to enjoy it. He still manages to lay the blame squarely on my aching shoulders, muttering something that sounds vaguely like ‘hereditary’.

He is a little more squeamish than I. His face screws up in horror as my wrist bones crunch back into place when he applies traction. It is, however, nice to regain freedom of movement occasionally. So I make him do it…

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A Down Sizing

Mission San Jose in San Antonio

I see and touch an awful lot of breasts. 

Just about every “uninhanced” woman on the face of this Earth has one breast that is slightly larger than the other. I certainly do. As I age it becomes more and more obvious… the left is fuller than the right. Every time I put on a bra or look in a mirror, I am acutely aware of it and I wonder if other women notice or care about their subtle discrepancies in size. Not that I would ever bring it up in the clinic, mind you. That would be akin to your beautician asking if you want her to wax your upper lip… creates a paranoia if there was not one there to start with. 

Thankfully, I have never had a man look at my chest and run away screaming.

Every once in a while I come across a patient with a more dramatic mismatching, like the woman with one breast a cup size A and the other one a size DD. It created a serious self esteem issue. She had never had a relationship as she was terrified of anyone see her naked. She stuffed her bra with whatever she could find until someone sewed her a pillow to tuck in there instead.

Hey! Sugery can FIX that for you…

You would think this would be a no-brainer, but no…. Invariably the response from insurance companies on the request for augmentation or reduction is, “Not medically necessary.”

I always wonder who the people are making these decisions. Men? Women? If a man, would a woman make a different decision? Or vice versa?

I know the angst I have had over the years over my slightly different sizes. I cannot imagine the psychological burden carried by these women with their really noticeable differences. So what determines medical necessity? We allow breast reconstruction in breast cancer. Is is “medically” necessary? Maybe not. But it is psychologically necessary. 

So then, what determines something being psychologically necessary? What size disparity is traumatic enough to warrant coverage? One size? Two? Four? How do you measure something so subjective?

And then what else causing cosmetic angst should be covered? I had a mole removed from my face while I was still in med school. Right next to my left nostril. It wasn’t huge in real life but in my brain it covered half my face. Best thing I ever did for myself, getting that sucker whacked off. 

So, what are your thoughts? How is your breast size? What do you think about insurance covering breast augmentation or reduction? 

What Is Left

Submarine hatch
“What are you doing to me?” he asked sharply. 

I shoved a pair of new pajamas into the drawer and closed it, turning around to face him.

He sat on the edge of the bed. A once tall and proud man, he was now withered and shrunken. His eyes accused me. Of what, he was no longer certain, but he was absolutely sure I was guilty.

He was right.

“This isn’t a cruise ship is it?” I shook my head. “I lost my wallet and haven’t got any money.” The anger in his voice was replaced by fear.

I patted his hand reassuringly. “It’s rehab, hon. You’ll be back home before you know it.” The lie burned my throat as I said it but it mollified him for the moment.

The roommate sat across the room watching our exchange silently from his wheelchair, wrapped in a plaid robe with white socks pulled up to his knees. His grizzly, stubbled face showed no sign of recognition or understanding but his eyes followed me suspiciously about the room. 

“I’ll see you tomorrow.” I bent low, kissing the wrinkled forehead, and squeezing his hand. He smiled weakly. 

I’d loved him. Once. 

Now someone else was living in this body of his. There was distance between us that stretched much father than the few inches apparent to the casual observer. I felt nothing for this interloper, but still there were social expectations that had to be met, guilt that must be assuaged.

How often must I visit him to keep from being ostracized by friends and family?

Somehow I deserved this, I had no doubt, but he did not.

I understood now, I realized, as I walked down the corridor for the hundredth time. This must have been how Prometheus felt.

Chimera

Small white flower bloom

I read the chromosomal analysis.

Partial trisomy of sex chromosome… mosaicism…

Well. What was that going to mean? I needed an answer before I called this baby’s mom. She had been waiting anxiously throughout her pregnancy after the initial testing had showed a probable genetic anomaly. Mosaics are tricky. Some cells are normal. Some are not. The end result can vary. I searched everywhere at my disposal professionally. 

Nothing. 

So then I turned to Google. 

“Likely no developmental delays. No fertility issues. Phenotypically normal appearance.”

I breathed a sigh of relief. I was still sending them to genetics but I wanted to be able to reassure the family if I could. It had been a very emotional pregnancy.

And since then I have been thinking about this more and more.

Now that OB/Gyns are offering, and sometimes pushing, these more advanced genetic tests during pregnancy I wonder what it is going to mean for the babies as they grow up. We would have never known there was an issue genetically for this child 10 years ago. We just would not care. They would have grown up as a “normal” child. Now this kiddo will have “sex chromosome anomaly” hanging around their neck for the rest of their life. 

Is more information really better? Just because we can do something… should we?

Maybe not.

Pecking Order

Flamingos fighting

Just take a nip 
Here and there
So I can be pretty
Fix my hair
Pull and tuck
Gouge at my eyes
Make me look pretty
Slim my thighs
Whiter teeth
A larger bust
I’m still not pretty
Another adjust
Raise those cheeks
Now my nose
Got to look pretty
Paint my toes
Some fuller lips
Sharper jaw
She is so pretty
Fills me with awe
Chisel me down
Tighter skin
I could be pretty
If I were thin
Sew me up
Dress me up
Give me more pain
So I can feel alive
So I can feel loved 
Still not happy
Just a pinch more
Want to be pretty
Want to be adored
Soon I’ll be there 
You wait and see
Soon I’ll be pretty
Soon I won’t be me

Games Played

Pelican on the water

“The staff doesn’t like you. They are all scared of you.” She sat across from me, feigning concern.

“Why?” I felt my face redden and struggled to keep the emotion under control.

“They just think you are too demanding. You should stop talking to them. Let me handle it for you so they can be mad at me.” 

Too demanding? I was not being ugly. I just asked the front desk to check on a patient’s insurance coverage. How could that be construed as anything but an honest and necessary question so I could take better care of a patient? 

“If you have a problem, come to me and I will take it to them.” 

And with that I was not supposed to communicate directly with my staff anymore. Because they feared and disliked me. The practice administrator over her and HR supported this she said. 

Whatever. 

My head reeled. She left. I closed the door and had myself a good cry.

Unbeknownst to me, that office manager was telling the staff that she was the boss, not the physicians, that they should stop taking their concerns to us. If there was an unpopular decision the staff was told that it came from the docs even if it didn’t really. If it was something good, she told them that she had done everything in her power get us to reluctantly agree. She lied and lied and lied to the staff about everything.

If you have been reading my blog posts for a few years you may recall the angst of this period of time. How could I be doing the same thing I always did but now all of a sudden everyone thinks I am the bitch from hell? Is it really that I am so evil? Or is it that I am woman and as such people are taking everything I say and do and twisting it into something I am not? If so, why now? 

What was going on?!?!!??!!

I had this niggling suspicion, as my staff continued to leave the clinic one by one, that my office manager was not supporting the physicians or the staff, that there was something else going on to which I was not privy. I reached out to upper management and they listened for a change. Within a couple of months she was gone. It was startling how quickly that occurred. Typically there is a huge HR process and blah, blah, blah. At the time I felt guilty, terribly guilty, blindsiding her with it when HR showed up to escort her out of the building. I worried that I had destroyed her career. 

Yesterday I found out that there was an investigation going on, that each employee who had left the clinic during that period of time was approached by a contracted firm for statements as to why they left. The investigation supported what I was saying which was why upper management moved so quickly. But no one ever told me this occurred. I found this out from one of the employees that we rehired. 

In fact, virtually everyone who has left this clinic has asked to come back at one time or another. On some level I knew it was not really me but how to rationalize that with what I was being told by an office manager that I trusted?

That whole period of time really messed with my head.

Friends and family started to doubt me. Hell, I doubted myself. I questioned my judgement. I questioned everything. In the end I realized that I had to let it go. All I could do was what I thought was right and I found my peace with that. While the maelstrom swirls around me, I can stand upright knowing I am doing right. In that respect the whole experience has been invaluable. I care so much less what people think about me. 

Just do what is right.

I have been back to communicating directly to my staff again for over a year. The practice administrator last week complimented me on my “level of engagement with the staff,” saying that everyone always had positive things to say about me.  

Ok. 

But I am doing the same thing I have always done. Maybe it is just the tequila I keep in my office?